|
WHEN THIS COPY CADDIES THE RAISED SEAL OF THE NEBRASKA STATE
<br />DEPART MT OF HEALTH, IT CERTIFIES THE
<br />OF AN ORIGINAL RECORD ON FILE WITH THE
<br />BUR-
<br />AU OF VITAL STATISTICS, WHICH IS T
<br />VITAL RECORDS.
<br />DATE OF ISSUANCE
<br />AU6 8 SM
<br />LINCOLN, NEBRASKA
<br />STATE OF mEMASKA- OEMRTMENT OF KITH
<br />s11mEM W VITAL STAnsTICS
<br />CERTIFICATE OF DEATH
<br />POST UST San M fw.. D•,. rr I
<br />Robert Berdon Saladen 12 Maley July 30, 1986
<br />!- fefq_WMP. Awr%,.. ORTOMNDESCtM IwR..MM%...M «'sM.
<br />Fnli�.. •AIJ(f►«IY> O•..�•.. IAa )( /o.PF_I _tf_L lil (DrOnE.) - — —� IDAT '
<br />DATE Of 11400116N.. D.Y. r,.l
<br />tr. DAYS . - HOMS. 'I LUnvomFr
<br />10_ 1991
<br />STATE OF MtfI ( t i. U.S.A.. C171 ZEN OF WHAT COUNTRY . "MR MARRIED. NAME OF SPOUSE IMF h. V. «•%Mw'•.'.1
<br />rC7,VV, j WIDOWED. DNOECED(S►«4) Cloud, Neb raska i, USA lR Married n Harie I. Blum
<br />HUA1RRR USuAt OCC,(FAt1oN(G«• i..r d w,S /..• r,,..q..w !!KeD P S LNESS OE,NDUSTp- COYNn or DEATH
<br />�,! „h.,,+,,;, etai� auto suppl -01 -1583 u.$a-f esman lnr store I1.. Adams
<br />Np/OCA1,0.1 OF pEATN INSWE CITY WMTS j HOSPITAL OR OTHER INSTITUTION- 1Nr fN...1.w •.IAN. .HOW OR IHSr r.•..N DOA • « «N•1 !R %w ,A•.I ••I..r.Mr) Cl..r•.:...If_ Ir.I.,. _(3r «111
<br />tin s lI Yes 1wMary Lanning Hospital TIN Inpatient
<br />E -STATE COUNTY , CITY. TOWN M LOCATION STRflT AMD NUANFR INSIDE CITIIAN.)
<br />N•1
<br />raska la Adams ilsliastins IISI 714 East 4th St. �IN Yes__
<br />♦ _ U : MOTHER - MAI M NAME CIE-- -
<br />Wallace Berdon _Salade_n ,? _ _ Blanche May Shirir
<br />WAS DECEASED EM IN U S. ARMED PCRCEST j INFORMANT - NAW -- RnANONSMIP - WAKING ADDRESS 131x.1 W t r O WI CT fM'0 —. 51"1” ! »I
<br />. r .tlRi tI r «. iW+ rr w ••w d .r....?
<br />,!Yes 1,WWII,7 -31- 42/12 -3 -45 tFMarfe I. Saladen;W:LeP714 E. 4th St.. Has tinYs.NE.68901
<br />RUeAI. Cr•.•r:•e. CEMETlRY Or CRtAMFOfT -NAM! , LOCATION CITY OR (OWN STATE
<br />".Burial �fw Aug. 2, 1986 'mParkviev Cemetery,__________ _— Hastings. Nebrask
<br />- _sort" nw t aK�SE FUNERAL HOMf --NAME AND ADDRESS 111NE1 p R.1 D NO_ CnY d,(IWN, STAtl. 11r1
<br />L _ Hastings, Nebraska 68901
<br />2, a Awe_ ___i2:Livin sg ton- Butler- Volland Funeral Home 1225 North Elm,
<br />DATE OF DEATH (AM.. D.Y. ►,.1 K "to UCH10 rm. ,, r,) HOUR Of DEATH
<br />w� �2N �ZN _ M
<br />DATE 11POHID (AN., D.P. r, 1 MOUE DEATH G PRONOUNCED OE♦D PRONOUNCED DEAOIN...0
<br />u. 2R,.. V r r I�1► ff[ ��' M Y!2' .24. 124L M
<br />.� N IV Mr .I ., 1•.••1••P•• ArM «....M M M w. w i.• r M j i V O..w t... A w.r,Ar N+NN A•'•niP•�••. %.., w.•)•. •,M wa...,• N
<br />_ ..wIM Mi • 1 M w..•. M, w N«. w Mw + M ou+ltl M.M•
<br />CE 1 IPM IAN,
<br />FS PRY tLN OR COUNTY AItORNEr) (irN W P•+.•i
<br />wn ac rvED Rr RE rw . w,, r.1
<br />� � �.. AUG 7 M6
<br />fAVAMMI fR•I ► -
<br />1 ! -- - f[N/tr CINIr ONE C SF PER LINE FOR (.1. (Ri. AND tan t•+••••i •.�+•� +••� ••A 4NA
<br />PART
<br />C--fs /�++
<br />rtll6 v(Y!'ax u♦ /t''/ �___ - _.._______ —_._ — �'w"1�
<br />I ♦ CURISIQUENCII d
<br />AS A CONSEQUIZ:5 OF" .rte .. /� __ - 1�tLf� /� __ _ - _ _______ —__ — L✓
<br />OUt t0, OR �•`�K Ste« w
<br />P '
<br />i,EMM . WAS TMIN • wrpyr ! wAi CAM 1 CERR V .IOKM
<br />rr.l4wMC1 NI tIIt rATt,IaON1N,> i i« <•1, r« .. ,.., s-4, p COrOrHR�
<br />IT ACCwRrr. iNl(IM. MOIrCM. y,IR,I i DAii d .aiurl e,r Mr •, . ±nOUF of 1W V« (WKM! .10'. plluRl OCCUR"
<br />OR 01.00.0 IN.,S11fiA1WI, 53/«1,1
<br />' M�J
<br />nACF OF .uun - T1E11 OR R, D w CNT CH 1pr•M TSAIf
<br />j rt,wi, A... wAY �ilNw •MiMF. M� f SMS.Ir
<br />Lot Six (6), Amick Acres Second Subdivision in Section Two (2),
<br />Township Nine (9) North, Ranqe Ten (10), West of the 6th P.M.,
<br />Hall County, Nebraska.
<br />1
<br />I
<br />
|